Jared Loughner’s Mental Health Could Determine His Punishment

The Arizona shooting suspect’s legal team is likely to use a mental defense, which could leave him in a hospital, rather than in prison, for life, a forensic psychiatrist tells Eve Conant. But whether Loughner ever sought or needed mental-health care is unclear.

The FBI and the Pima County Sheriff's Department investigate the crime scene of the Safeway store a day after Jared Loughner (Inset) opened fire on a group of people on January 9, 2011 in Tucson, Arizona. (Photo by Kevin C. Cox / Getty Images),Kevin C. Co

The Arizona shooting suspect’s legal team is likely to use a mental defense, which could leave him in a hospital, rather than in prison, for life, a forensic psychiatrist tells Eve Conant. But whether Loughner ever sought or needed mental-health care is unclear. Plus, full coverage of the Arizona shooting.

Answering that question is the crucial next step in the investigation and criminal case for Saturday’s shooting spree that left six dead, Rep. Gabrielle Giffords critically wounded, and 14 injured.

“You can take it to the bank that lawyers will raise a mental defense. There is zero question in my mind about that,” said Steven Pitt, a forensic psychiatrist and consultant to the Phoenix Police Department. “The case is not a whodunit. It’s a case about why he did it and why he did it now.”

The first question, said Pitt, a clinical associate professor of psychiatry at the University of Arizona College of Medicine in Phoenix, will be whether Loughner is competent to stand trial. Ultimately, conclusions reached about his mental state at the time of the attack could determine “whether he spends the rest of his life in a psychiatric or a correctional facility,” said Pitt. ( News reports say the death penalty might also be considered.)

“To say that Loughner had a mental illness, or that he might have been denied services, these are things we just don’t know,” said Pitt.

It’s unclear if Loughner either needed or sought mental-health care in the Tucson area, where he lived. But for those suffering from mental illness, Arizona has become a challenging state to live in. The state has seen a $65 million drop since 2008 in behavioral health services for Arizonans who don’t qualify for the state’s version of Medicaid, representing a 51 percent reduction over the last three fiscal years, according the Arizona Department of Health Services and a detailed December report on health care in the Arizona Daily Star. Some $36 million was slashed early last year, and Gov. Jan Brewer called the cuts, which affected some 12,000 adults and 2,000 children, “tough” and “painful,” according to The Arizona Republic, which also has reported that she has dealt personally with mental illness in her family.

Arizona’s budget woes are not unique—other states are confronting cuts to mental-health services and corresponding problems for local police. Former U.S. Surgeon General Dr. Richard Carmona, a friend of Rep. Giffords and her family, told The Daily Beast that calls to fix America’s mental-health-care system are missing the point. Integration of care is vital, he said: “We don’t have a mental-health system in the U.S. We have good professionals, but we don’t have an integrated common policy, and with cuts like this, there will be more problems in a system already strained.”

Carmona said the “opportunity cost” of decisions to cut care must be examined, both in Arizona and nationwide, and he asked, “What will it cost us in terms of the cost of putting more people in prisons and jails?”

Phoenix Mayor Phil Gordon said he has many FBI and law-enforcement colleagues “who tell me they are concerned” about people with mental-health problems out on the streets, especially given the state’s warm weather, which attracts out-of-state drifters. (Law-enforcement officers reached both in the Phoenix police and the Pima County Sheriff’s Department said they have not noticed a spike in encounters with mentally unstable citizens in the wake of the budget cuts, but that such encounters are a constant part of the job.)

H. Clarke Romans, executive director of the southern Arizona affiliate of the National Alliance on Mental Illness, said he has combed his data records to see if Loughner made any contact with Romans’ organization, which helps provide education and support services for people suffering from depression, bipolar disorder, and schizophrenia, among other mental-health issues. “If you go back to July 1 of last year, due to state budget cuts, people who suffer from serious mental illnesses [and are not covered by Medicaid] basically lost all their services, with the exception of access to generic medications,” he said. That includes losing access to case managers, doctors, coverage for brand-name medications, ability to take part in support groups, transportation, and even housing subsidies. Some 3,500 people in the Pima County area have lost services, he said, with more than 10,000 suffering from the cuts statewide.

Loughner’s behavior raised mental-health “red flags” for Romans, and for law-enforcement officers in the Pima County Sheriff’s Department who have been dealing with the case and reporters poring though the suspect’s Internet ramblings. “Things that have been found out certainly lead to concerns about his mental health. But that’s for someone professional to look at,” said Capt. Chris Nanos, of the criminal investigations division.

“In hindsight, I suspect we will learn that lots of different people had bits and pieces of information that if connected would have painted a compelling picture of a troubled individual,” said Pitt, the forensic psychiatrist.

According to a press release from the college, “A followup letter was sent to him October 7, 2010 indicating that if he intends to return to the college, he must resolve his Code of Conduct violations and obtain a mental-health clearance indicating, in the opinion of a mental-health professional, his presence at the college does not present a danger to himself or others. After this event, there was no further college contact with Loughner.”

The inner workings of Loughner’s mind between October and Saturday’s shooting will need to be examined closely, and so far Loughner is not cooperating with authorities. But “to say that Loughner had a mental illness, or that he might have been denied services, these are things we just don’t know,” said Pitt. “We have to be careful not to associate the unlawful decisions of a disaffected person to the budget woes of Arizona, or political rhetoric, or access to firearms.”